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About Us
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COVID-19 Procedures

Termination of Services/ Lay-off Certificate

PERSONAL DETAILS OF EMPLOYEE
National Insurance Number*
National Registration Number*
Name
First Middle Last
Address
District
Parish
Zip/Postal Code
Tel. No.
Cell No.
Email
EMPLOYER DETAILS
Name of Employer
Employer's Registration No.*
Address
District
Parish
Zip/Postal Code
Tel. No.
Fax No.
EMPLOYMENT DETAILS
Occupation
Position within Organisation
Date Employment Commenced
DD slash MM slash YYYY
Date of Termination
DD slash MM slash YYYY
Last date at work
DD slash MM slash YYYY
Last date for which employee will be paid
DD slash MM slash YYYY
State reason for unemployment
Was employee Laid off?
- Yes
- No
Date of Lay off
DD slash MM slash YYYY
Expected date of re-employment
DD slash MM slash YYYY
OTHER DETAILS
Is the employee receiving or entitled to pension from employer?
- Yes
- No
Start date of pension
DD slash MM slash YYYY
Was holiday pay given to employee who was laid off?
- Yes
- No
From
DD slash MM slash YYYY
To
DD slash MM slash YYYY
Amount of holiday pay?
Was the employee dismissed because of his/her own misconduct?
- Yes
- No
Explain
Did the employee voluntarily leave your employment?
- Yes
- No
Has the employee become unemployed because of stoppage of work attributable to a labour dispute at your workplace?
- Yes
- No
Is/Was the employee participating in a strike?
- Yes
- No
Any other relevant details?
I declare that the information given on this form is true to the best of my knowledge and belief.
Signature of Employer*
Date signed*
DD slash MM slash YYYY
WARNING: ANY PERSON WHO MAKES A FALSE STATEMENT IS PUNISHABLE BY A FINE OR TERM OF IMPRISONMENT OR BOTH.

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